Holland’s United Methodist Church / We are an Equal Opportunity Employer and are committed to excellence through diversity. / Please print or type. The application must be fully completed to be considered. Please complete each section, even if you attach a resume.
Personal Information
Name
Address / City / State / Zip
Phone Number / Mobile Number / Email Address
Are You A U.S. Citizen? / Have You Ever Been Convicted Of A Felony?
Yes / No / Yes / No
If Selected For Employment Are You Willing To Submit to a Pre-Employment Drug Screening Test?
Yes / No
Position
Position You Are Applying For / Available Start Date / Desired Pay
Employment Desired
Full Time / Part Time / Seasonal/Temporary
Education
School Name / Location / Years Attended / Degree Received / Major
[
References
Name / Title / Company / Phone
Employment History
Employer (1) / Job Title / Dates Employed
Work Phone / Starting Pay Rate / Ending Pay Rate
Address / City / State / Zip
Employer (2) / Job Title / Dates Employed
Work Phone / Starting Pay Rate / Ending Pay Rate
Address / City / State / Zip
Employer (3) / Job Title / Dates Employed
Work Phone / Starting Pay Rate / Ending Pay Rate
Address / City / State / Zip
Employer (4) / Job Title / Dates Employed
Work Phone / Starting Pay Rate / Ending Pay Rate
Address / City / State / Zip
Employer (5) / Job Title / Dates Employed
Work Phone / Starting Pay Rate / Ending Pay Rate
Address / City / State / Zip
Signature Disclaimer
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Name (Please Print) / Signature
Date
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